CLAYTON BLOCK COMPANY, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN
401k plan membership statisitcs for CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN
| Measure | Date | Value |
|---|
| 2021: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-11-01 | 297 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-11-01 | 273 |
| Total of all active and inactive participants | 2021-11-01 | 273 |
| 2020: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-11-01 | 318 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-11-01 | 297 |
| Total of all active and inactive participants | 2020-11-01 | 297 |
| 2019: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-11-01 | 347 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-11-01 | 318 |
| Total of all active and inactive participants | 2019-11-01 | 318 |
| 2018: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-11-01 | 351 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-11-01 | 347 |
| Total of all active and inactive participants | 2018-11-01 | 347 |
| 2017: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-11-01 | 340 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-11-01 | 351 |
| Total of all active and inactive participants | 2017-11-01 | 351 |
| 2016: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-11-01 | 326 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-11-01 | 340 |
| Total of all active and inactive participants | 2016-11-01 | 340 |
| 2015: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 328 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 326 |
| Total of all active and inactive participants | 2015-11-01 | 326 |
| 2014: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 313 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 328 |
| Total of all active and inactive participants | 2014-11-01 | 328 |
| 2013: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 327 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 313 |
| Total of all active and inactive participants | 2013-11-01 | 313 |
| 2012: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 351 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 327 |
| Total of all active and inactive participants | 2012-11-01 | 327 |
| 2011: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 425 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 351 |
| Total of all active and inactive participants | 2011-11-01 | 351 |
| 2010: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 396 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 425 |
| Total of all active and inactive participants | 2010-11-01 | 425 |
| 2009: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 405 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 396 |
| Total of all active and inactive participants | 2009-11-01 | 396 |
| 2021: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2021 form 5500 responses |
|---|
| 2021-11-01 | Type of plan entity | Single employer plan |
| 2021-11-01 | Plan funding arrangement – Insurance | Yes |
| 2021-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2020 form 5500 responses |
|---|
| 2020-11-01 | Type of plan entity | Single employer plan |
| 2020-11-01 | Plan funding arrangement – Insurance | Yes |
| 2020-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2019 form 5500 responses |
|---|
| 2019-11-01 | Type of plan entity | Single employer plan |
| 2019-11-01 | Plan funding arrangement – Insurance | Yes |
| 2019-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2018 form 5500 responses |
|---|
| 2018-11-01 | Type of plan entity | Single employer plan |
| 2018-11-01 | Plan funding arrangement – Insurance | Yes |
| 2018-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2017 form 5500 responses |
|---|
| 2017-11-01 | Type of plan entity | Single employer plan |
| 2017-11-01 | Plan funding arrangement – Insurance | Yes |
| 2017-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2016 form 5500 responses |
|---|
| 2016-11-01 | Type of plan entity | Single employer plan |
| 2016-11-01 | Plan funding arrangement – Insurance | Yes |
| 2016-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CLAYTON BLOCK COMPANY INC AND AFFILIATES PREMIUM ONLY PLAN 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 9372 |
| Policy instance | 4 |
| Insurance contract or identification number | 9372 | | Number of Individuals Covered | 523 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $6,638 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,638 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 851Q3 |
| Policy instance | 3 |
| Insurance contract or identification number | 851Q3 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $462,489 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BKPX |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0BKPX | | Number of Individuals Covered | 273 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $2,422 | | Total amount of fees paid to insurance company | USD $2,095 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $24,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,422 | | Amount paid for insurance broker fees | 2095 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30003843 |
| Policy instance | 1 |
| Insurance contract or identification number | 30003843 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $1,568 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,568 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30003843 |
| Policy instance | 1 |
| Insurance contract or identification number | 30003843 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $1,637 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,040 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,637 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BKPX |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0BKPX | | Number of Individuals Covered | 297 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $2,724 | | Total amount of fees paid to insurance company | USD $2,242 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $27,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,724 | | Amount paid for insurance broker fees | 2242 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 851Q3 |
| Policy instance | 3 |
| Insurance contract or identification number | 851Q3 | | Number of Individuals Covered | 228 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $548,729 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 9372 |
| Policy instance | 4 |
| Insurance contract or identification number | 9372 | | Number of Individuals Covered | 544 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,014 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,014 | | Additional information about fees paid to insurance broker | N/A | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 9372 |
| Policy instance | 4 |
| Insurance contract or identification number | 9372 | | Number of Individuals Covered | 635 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $6,457 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,457 | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86603 |
| Policy instance | 3 |
| Insurance contract or identification number | 86603 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,387,748 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BKPX |
| Policy instance | 2 |
| Insurance contract or identification number | GLUG0BKPX | | Number of Individuals Covered | 318 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $2,880 | | Total amount of fees paid to insurance company | USD $492 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $28,797 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,880 | | Amount paid for insurance broker fees | 492 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30003843 |
| Policy instance | 1 |
| Insurance contract or identification number | 30003843 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $1,711 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,207 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30003843 |
| Policy instance | 1 |
| Insurance contract or identification number | 30003843 | | Number of Individuals Covered | 271 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $1,674 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,674 | | Insurance broker organization code? | 3 |
|
| UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 ) |
| Policy contract number | 131434 |
| Policy instance | 2 |
| Insurance contract or identification number | 131434 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $3,173 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $34,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,173 | | Insurance broker organization code? | 3 |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86603 |
| Policy instance | 3 |
| Insurance contract or identification number | 86603 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,217,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 9372 |
| Policy instance | 4 |
| Insurance contract or identification number | 9372 | | Number of Individuals Covered | 706 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,971 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,971 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 9372 |
| Policy instance | 4 |
| Insurance contract or identification number | 9372 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,845 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 86603 |
| Policy instance | 3 |
| Insurance contract or identification number | 86603 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,335,163 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNICARE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80314 ) |
| Policy contract number | 131434 |
| Policy instance | 2 |
| Insurance contract or identification number | 131434 | | Number of Individuals Covered | 351 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $3,127 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $34,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30003843 |
| Policy instance | 1 |
| Insurance contract or identification number | 30003843 | | Number of Individuals Covered | 278 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,676 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
